Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | ME111167 | FL |
NPI | 1356582381 |
---|---|
Provider Name | Mr. Bassan Jorge Allan |
First Address | Boston, MA 02111-1553 |
Second Address | Fort Myers, FL 33966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2009 |
Last Update Date | 23/05/2018 |